Hematology Flashcards
1
Q
Anemia
A
Male <13.5g/dl and <41% ht
Females < 12g/dl and <36% ht
2
Q
Causes of megaloblastic anemia
A
B12 and folate def
3
Q
Causes of non megoblastic macrocytic anemia
A
- Hypothyroidism
- Liver disease
- Bone marrow myelodysplasia (bone marrow aplasia: normocytic)
- Alcohol intake
4
Q
Parentral iron indications
A
- Rapid increase of stores
- Toxicity/ noncompliance of oral
- Malabsorption
- High rate of blood loss
5
Q
Dose of iron calculation
A
Iron deficit in mg= weight kg x (14-Hgb) x (2.145)+ (500 if need full store)
6
Q
Eitology of anemia of chrinic disease
A
- Impaired iron utilization
- Direct inhibition of erthropoisis
- Impaired erthrpoiten production
- Due to inflammatory cytokines
7
Q
Causes of aquired sidroplastic anemia
A
- Heavy metal poisoning lead and arsenic
- Copper and vit B6 def
- Zinc overdose
- Alcohol abuse
- Isoniazid, chloromphenicol, linzolid
8
Q
B12 dietary note
A
From animal products
Body store 5mg
Daily req 2-5 ug
Def is rare takes years
9
Q
Folate dietary note
A
Source is widespread
Def is common
Store 5mg
Daily req 50-200ug
10
Q
Symptoms and signs of B12 def
A
Anemic symptoms and signs plus
1. Neuropsychiatric changes
2. Peripheral neuropathy
3. Subacute combined spinal cord degeneration
4. Fissured sore tongue
5. Memory and vision problems
11
Q
Hypersegmented neutrophils
A
B12 def
12
Q
Homecysteine elevated in
A
B12 and folic acid def
13
Q
Elevated methylmalonic acid in
A
B12 def
14
Q
Prenicious anemia special tests
A
Anti-intrinsic factor Ab : specific only
Anti-parietal cell Ab: sensitive only
15
Q
Treatment of B12 def
A
Parenteral:
1mg/ day x 7 days
1mg/week x 4 weeks
1mg/month for life
Oral:
1mg/day for life
16
Q
Commonest cause of B12/ folate def
A
B12: prenicious anemia
Folate: dietary intake (alcohol&pregnancy)
17
Q
Spur cell hemolytic anemia
A
Due to advanced liver disease lead to increase in surface area without increase in volume (free cholestrol abnormality) = characterized by thorny surface and acquired nonimmune extravascular hemolysis
18
Q
PNH
A
C55,59 defect leads to night time hemolysis and thrombosis due to complement attack
Budd-chiari syndrome (venous thrombosis
19
Q
Hereditary spherocytosis
A
Autosomal dominant
Membrane spectrin/ankyrin abnormality
Spherocytes on blood film
Extravascular hemolysis
Splenomegaly
20
Q
Sickle cell anemia
A
Autosomal recessive
Beta globin 6 codon
Glu to valine or A to T
Functional splenectomy
21
Q
Pharmacologic elevation of HbF by
A
Hydroxyurea
22
Q
Warm hemolytic anemia
A
IgG mediated
23
Q
Cold hemolytic anemia
A
IgM mediated
24
Q
Treatment of Autoimmune hemolytic anemia
A
Treat cause
Prednisone. 1mg/kg/day for 2 weeks then taper
Splenectomy
Immunosuppressive agents Rituximab
IVIG
25
Ppt factors to sickle cell crisis
Hypoxia
Acidosis
Dehydration
Fever
Infection
Exposure to cold
26
Intravascular hemolysis
MAHA
Chemical exposure
ABO incompatibility
Infection
27
DD of MAHA
TTP
HUS
DIC
Mechanical valve
Pre-eclampsia and HELLP syndrome of pregnancy
Vasculitis
28
Cold AIHA notes
1. Cold temp 0-5 degrees
2. Igm and complement
3. Intravascular hemolysis and liver sequestration primarily
4. Positive DAT/Coombs test
5. Peripheral agglutination
6. Related to mycoplasma pneumonae, EBV, CMV
29
Warm AIHA notes
1. IgG mediated At 37degrees
2. Extravascular hemolysis, spleen primary sequestration site hence spleenomegally
3. Positive DAT/coombs surface IgG on RBC
4. Smear shows spherocytosis
5. Associated with lumphoploriferative ds, collagen ds SLE, drugs like methyldopa
30
Preservation of blood transfusion components
Red cells : 4 degrees for 35 days
FFP: -30 degrees for 36 months after thaw 24hr at 4 degrees
Platelets: 22 degrees for 5 days
31
F to Celsius conversion
((F-32) x5 ) / 9
32
Genes of ABO and Rh found on!?
ABO chromosome 9p
Rh chromosome 1
33
PRBC volume and ht
Volume 180-200ml
Ht: 65-75%
34
Whats the effect of 1 unit PRBC on Hb and Hct?
1 unit raises Hb by 1g/dl and hct by 3%
35
PRBC threeshold and target
Threshold is 7g/dl = 7 units
Hb Target in critical patients is 10g/dl
36
What is Single donor platelets
Jumbo platelets: From one donor; via aphaeresis machine, 200-400ml
1SDP = 6 units of RDP
37
How is random donor platelts RDP prepared
From whole blood by centrifugation. And is about 50-70ml
38
1 RDP increases platelet counts by?
5000-10000 in unsensitized pt without consumption (DIC splenomegaly..
39
Platelet target in surgeries is
50000
40
Indications of FFP
1. Warfarin reversal
2. Liver disease
3. DIC
4. Congenital bleeding
5. TTP
Volume : 200-250ml
Dose: 10-15ml/kg
41
Effect of 1 unit FFP on coagulation factors
Raises it by 2%
42
Contents of cryprecipitate
Fibrinogen, vWF, factor 8
43
Indications of cryopre
DIC
FIBRINOGEN < 100mg/dl
Hemophilia A
vWF ds
Volume 10-15ml and 1 unit contain 80units of factor 8
44
Name 4 Early immune complications of transfusion
1. Acute hemolytic TR
1. Febrile non hemolytic TR
3. Allergic non Hemolytic TR
4. Transfusion-related Acute lung injury
45
Name 6 non immune early complications of transfusion
1. Circulatory overload
2. Hyperkalemia
3. Bacterial infection
4. Citrate toxicity
5. Dilutional coagulopathy
6. Iron overload
46
Acute hemolytic transfusion reation
ABO incompatabiliy IgM mediated
Fever, chills, dysnea, back and flank pain, hypotension, intravascular hemolysis, hemoglobinuria, AKF,
47
Ektiology of acute febrile non hemolytic reaction
Donor cytokines attack the patient and patient attack donor’s WBCs and Platelets
Within 6hrs
48
Allergic non hemolytic reaction
IgE against donor’s plasma result in histamine release
49
Leading cause of transfusion related morbidity and mortality
TRALI
Occurs within 2-6 hrs
50
Managment of allergic acute transfusion reaction
If mild (urticaria :common) : slow transfusion rate + diphenhydramine
If modorate to severe: stop transfusion, IV diphenhydramine, steroids, epinephrine, IV Fluids, bronchodilators
51
CXR of TRALI
Bilateral interstitial infiltrate
52
When to stop transfusion
1. Acute hemolytic TR
2. Febrile non hemolytic reaction fever >or equal 39 with severe symptoms
3. Moderate or severe Allergic non hemolytic reaction
4. TRALI
5. Circulatory overload
6. Bacterial infection
53
Iron chelators
Deferoxamine and deferasirox
54
Delayed transfusion hemolytic anemia cause
Alloantibodies IgG against minor antigens eg Duffy and kell
Within 3-14 days
55
Transfusion associated Graft vs host disease
Transfused T lymphocytes react against host
In 4 to 30 days
Prevented by giving irradiated blood products
56
Gender ratio in bleeding disorders
Platelet > in females
Coagulopathy > in males
57
TT test for
Thrombin time: fibrinogen abnormality and heparin
58
Normal PT time
12-15 sec for extrinsic pathway
59
INR
PT of patient /PT of control ( 0.9-1.1)
For warfarin, liver ds, vitamin K status
60
APTT
For internsic pathway
25-39 sec
Monitor heparin treatment, antiphospholipid Ab, coagulation factor deficiency
61
Prolongation of both PT and APTT
1. Severe liver disease
2. Warfarin
3. Therapeutic fibrinolysis
4. DIC
5. Isolated fibrinogen, factors 2,5,10 def
6. Severe vit K def
62
Lupus anticoagulant
Prolongs APTT
63
Normal bleeding time
2-8 minutes
64
DD of ITP
1. In vitro platelet clumping due to EDTA
2. Pregnancy, hypersplenism, viral, drug
3. TTP, DIC, MDS, Autoimmune as SLE
65
ITP Therapy
1. Glucocorticoids
2. Rituximab
3. Splenectomy
4. Thrombopoitin agonist
5. Ttt H.pylori
Emergency ttt: glucocorticoids high dose and IVIG
66
Acquired qualitative platelet disorder
1. Uremia
2. Cirrhosis
3. Myeloproliferative disorders
4. Myeloma and related
5. Cardiopulmonary bypass
6. Drugs and ethanol
67
Most common congenital bleeding disorder
vWF def
68
MM criteria
2 out of 3
1. Plasma cells < 10%
2. Paraprotiens in blood or urine
3. Osteolysis
69
Follow up test for MM
LDH and B2 microglobin
70
C/P of MM
CRAB
Hypercalcemia without ALPase
Renal impairment
Anemia
Bone lesions
71
4T of HIT Types 2
Thrombocytopenia (<50%)
Thrombosis (due to platelet clumping)
Timing 5-10days after heparin
Thrombocytopenia (of no other cause)
72
HIT2 eitiology
Ab against PF4
Immune mediated need to stop heparin and give another type of anticoagulant not heparin based
73
How to differentiate AML from ALL
AML is myeloperoxidase +ve and auer rods
More common in adults
74
Leukomoid reaction
TLC not more than 100K/mm3
High NAP score (neutrophil alkaline phosphatase)
75
Good prognostic marker of CML
Philadelphia Chromosome (9:22 long arm translocation)
76
Massive spleenomegally in?
CML
Myelofibrosis
Stage 3 of hepatic schistosomiasis
77
Relative thrombocytopenia
Acute: dehydration
Chronic: HTN and o o obesity
78
Absolute polycythemia
True incr in RBC mass
1. Primary JAK2 mutation
2. Secondary: incr EPO or hypoxia
79
DD of Dry BM tap
1. Myelofibrosis (tear drop and massive spleen)
2. Hairy cell leukemia
80
Pruritis
1. Hodgkin lymphoma LN with alcohol intake
2. Polycythemia vera after hot bath
3. Fat embolism (usually rash on chest/back)
81
High ESR
TB
Lymphoma
Pyogenic liver abscess
82
DD epitrochlear LN
1. Nonhodgkin
2. HIV, EBV
3. CLL
4. TB, sarcoidosis
5. Syphillis
83
LDH in lymphoma
Is of bad prognosis
84
Definitive diagnosis of lymphoma
LN biopsy
85
Low ESR
Sickle cell
86
CML genetic abnormality?
Philadelphia chromosome t9:22 BCR-ABL
87
Blast crisis of CML
When it accelerates and transforms to AML/ ALL
88
How to differntiate between increase RBC due to PV or Chronic hypoxia or RCC
By performing ABG and EPO level study
89
What is the genetic mutation in polycythaemia vera?
Acquired JAK2 mutation: cytoplasmic
90
C/P of polycythaemia vera
Aquigenic pruritis (hot water bath)
hyper-viscosity -> thrombosis such as bud chiari syndrome
Headache
Hypertension
Plethora and flushing
91
Treatment of polycythemia vera
Phlebotomy
Hydroxyurea
Ruxolitinab (jak2 inhibitor)
92
What is erythromelalgia
Severe burning pain and red blue discolouration due to episodic blood clots in the vessels of extremities And this can be seen with polycythemia vera and essentials thrombocythemia
93
Mention some causes of increased platelet count
Essential thrombocythemia
Polycythemia vera
CML
Iron def anemia
Acute bleeding/hemolysis
Infection and inflammation
Metastatic cancer
94
Abnormal finding in myelofibrosis
Extensive fibrosis
Dry tap
Tear drop RBCs
Huge spleen
Variable findings of Plt and WBCs
95
Increase abnormal platelets only
Essential thrombocythima
96
Pseudo-pelger-hüet anamy
CML
97
Toxic granulations and Döhle bodies
Neutrophil morphology in Leukamoid reaction
98
What is the cell that leads to the development of myelofibrosis of BM
Megalaryoctyes : secrete TGF-B and PDGF
99
Whats the esinophil and basophil levels in leukamoid reaction versus CML
Leukamoid: normal
CML: increased
100
Plasma volume is increased/decreased in polycythmia vera
Increased
101
T(8:14)
Burkitt lymphoma (c-myc activation)
102
t(11,14)
Mantle cell lymphoma (cyclin D1 activation)
103
t(11,18)
Marginal cell lumphoma
104
t(14,18)
Follicular lymphoma (BCL-2 activation)
105
t(15,17)
M3 AML (APL acute promyelogenic leukemia)
Responds to All trans retinoic acid
106
Down syndrome associated with?
AML
107
Birbeck granules
Langerhans cell histocytosis
Express s100, CD1a
